Recognition of the magnitude and location of mechanical conflicts is critical to reliably and reproducibly improve functional range of motion and outcomes after surgical treatment of femoroacetabular impingement (FAI). The purpose of this study was to assess the ROM and location of intra-articular and extra-articular mechanical conflict with seven commonly performed physical exam manoeuvers in a cohort of hips with symptomatic FAI. Internal rotation in flexion results in mechanical contact between the anterolateral and anterior femoral head-neck junction with the acetabulum, most commonly at a 1:15 o'clock position. Associated adduction, however, significantly reduces the available internal rotation secondary to contact in the same locations. Straight abduction results in mechanical conflict between the superior femoral head-neck junction and the 12:00 o'clock position of the acetabulum. With external rotation of the hip in various degrees of hip flexion, the potential mechanical impingement is extra-articular between the greater trochanter and ischium or pubic ramus. The zones of proximal femoral and acetabular contact are not intuitive, and may extend significantly more laterally and distally on the femoral head-neck junction than previously appreciated.
The increasing number of total knee arthroplasties, in combination with the population's longer life expectancy, has led to a greater number of long-term complications. These add to the poor bone quality of elderly patients and often culminate in periprosthetic fractures. This complex orthopedic problem has a great diversity of clinical presentation. It may affect any of the bones in the knee and, because of the difficulty in finding solutions, may lead to disastrous outcomes. Its treatment requires that orthopedists should have broad knowledge both of arthroplasty techniques and of osteosynthesis, as well as an elaborate therapeutic arsenal including, for example, access to a bone bank.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.